Original reportImpact of the 80-hour Workweek on Surgical Exposure and National In-Training Examination Scores in an Orthopedic Residency Program
Introduction
Residency programs across the country have undergone restructuring because of the recent guidelines put forth by the Accreditation Council for Graduate Medical Education (ACGME) in 2003.1 Guidelines specify that a resident may not work greater than 80 hours a week averaged over a 4-week period, no new patient contact is allowed after 24 hours on duty, a work day cannot be greater than 30 consecutive hours, and a resident must have off 10 hours between call and returning to work.1, 2 Because of the work-hour regulations, surgical and nonsurgical programs around the country have instituted innovative solutions to accommodate the changes, which include hiring physician extenders, using at-home call, establishing surgical skills laboratories, and developing a night float system.3, 4 Recent articles have discussed several aspects of the impact of work-hour restrictions on patient mortality, resident family birth rates, and resident perception of quality of life.5, 6, 7 Limited data discussing the specific impact of the work-hour restrictions on orthopedic surgical training and knowledge are available.
In this article, we evaluate the impact of the new work-hour regulations on the surgical exposure and educational development of residents in a single 3-resident-per-year orthopedic program. To evaluate surgical exposure specifically, we collected logged CPT codes in the ACGME data bank for PGY-2 through PGY-5 residents from 2000 to 2008. To evaluate educational development, we examined raw orthopedic in-training examination (OITE) scores of PGY-2 through PGY-5 residents 3 years before and 5 years after the work-hour mandate. For reference in this article, a PGY-2 designated year is the first year of orthopedics after completion of a general surgery intern year.
Section snippets
Materials and Methods
ACGME resident case logs were used from a single orthopedic residency program, which featured volunteer, private, and full-time academic faculty. Data were collected for 3 academic years before and 5 years after the initiation of work-hour regulations on July 1, 2003. All residents in training PGY-2 through PGY-5 were included. PGY-1 residents were excluded because they were not required to log CPT codes with the ACGME, and therefore, reporting would not be consistent. During evaluation of OITE
Results
Thirty-five individual resident years before 2003 and 62 resident years after 2003 were available for analysis. The average number of cases performed per year before 2003 was 464.4 compared with 515.5, with a net gain of 51.2 procedures after 2003. The average number of cases performed before the work-hour restrictions was 480.1 for PGY-2s, 457.7 for PGY-3s, 499.6 for PGY-4s, and 424 for PGY-5s. After implementation of the 80-hour workweek, the average number of cases performed was 541.8,
Discussion
This study was undertaken to assess the impact of the 80-hour workweek on a single orthopedic residency program. Since discussion first began of work-hour reform, both residents and attendings showed concern that surgical resident training would be negatively impacted because of work-hour restrictions.3 We found no evidence of decreased surgical exposure in our residency program based on the specific criteria of logged CPT codes. Contrary to anticipated results, the number of procedures
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Noticeable Variations in the Educational Exposure During Residency in Danish Orthopedic Departments
2016, Journal of Surgical EducationCitation Excerpt :This raised a concern that the restrictions would have a negative influence on education, as it has been hypothesized that the quality of education is correlated to the number of hours spent at work during education.4-8 It seems though that the operative experience has not suffered during residency following the restriction.5,8 This is an important finding for the US residents, but it is difficult to transfer to a Danish context with a 37-hour workweek.
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2011, Journal of Surgical EducationOperative volume in the new era: A comparison of resident operative volume before and after implementation of 80-hour work week restrictions
2010, Journal of Surgical EducationCitation Excerpt :All studies published before 2009 evaluated residents that had completed some part of their residency before the implementation of the 80-hour-work-week restrictions. Recently, Froelich et al.20 published a study of orthopedic surgery residents at a single institution that included PGY-5 residents that had completed their entire residency under the restrictions. They found no statistical difference in operative volume when comparing residents before and after the restrictions.